GU Flashcards by grace Kennedy

Testicular torsion is most common at what age?

Adolescence 12- 16 yrs

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Torsion of hydatid of Morgagni is AKA? Common age of presentation

AKA torsion of testicular appendage
Usually pre pubertal males

Note: blue dot sign - tender nodule with blue discoloration on the upper pole of the testis

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Blue dot sign is seen in what pathology?

Torsion of testicular appendage

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Torsion of testicular appendage require surgical intervention T/F

F - if diagnosis is clear not indication for surgery, symptoms should resolve w/in 48 hrs

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Management of a hydrocele?

If < 2 yrs reassurance only, 95% will resolve by 2 yrs old

If > 2 yrs old ligation of processus vaginalis

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Mgmt of priapism?

Mgmt is different for ischaemic vs non ischaemic

Ischaemic is painful and non ischaemic is not

Ischaemic is an emergency - needs surgery consult. Tc ice pack, oral analgesia and cavernous phenylephrine and aspiration if there for > 4 hrs

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What is the only absolute medical indication for circumcision?

BXO (balantitis xerotica obliterans)

Note: as 10% of cases will have narrowing of urethra and hence urethral calibration is also indicated.
Other relative indications: recurrent paraphimosis, posterior urethral valves or high grade VUR (due to abnormal tract/increase risk UTIs)

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Balantitis xerotica obliterans vs phimosis

BXO - thickened non retractile foreskin, it does not evert and is scarred. Leads to a pin hole opening

Phimosis: non retractile foreskin, mild erythema, ballooning of foreskin on micturition and white debris

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What is the mgmt of phimosis in a baby?

Reassurance; foreskin in only retractable in 1% of babies at birth; only 1% of 16 yrs old will have a foreskin that is non retractable

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Presence of pus cell in the urine of a pt who has recently been started on a new medication.

Acute interstitial nephritis

Common meds: beta lactams, sulphonamides, rifampicin, ethambutol, erythromycin

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What is the mgmt of a chronic ovarian cyst > 5cm?

Ovary sparing cystectomy

At 5cm or greater there is a risk of torsion

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According to NICE guidelines in a child over 3 yrs old what is the appropriate duration of treatment with oral abx for cystitis?

3 days

NB: pyelonephritis is 7-10 days

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In hypospadias where does the urethra open?

Ventrally just before the glans

Other features: a chordee (tilt ventrally) and hooded foreskin
Note: epispadias is much less common and is an opening on the dorsal side

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What is the mgmt of the lack of a palpable testis?

Normal up until 6 months

After 6 months should have a diagnostic laparoscopy and possibly the first stage if orchidopexy.

NB: no form of imaging is reliable enough to determine whether a testes is present or not

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Vesicoureteric reflux is most accurately diagnosed by a DMSA scan T/F

F - DMSA scan is the best investigation to look for renal scars
Micturating cystography is used for diagnosis

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Most vu reflux spon resolves the age of 3 yrs T/F

F - most resolves by 5 yrs

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Of children who present to the hospital with a UTI about what % have VUR?

30 - 40%

Umbilicus draining in a infant, differentiate patent vitellointestinal remnant from urachal sinus

Patent vitellointestinal remnant - more likely to drain pus or intestinal contents
Patent urachal sinus - as is bladder, more likely to drain clear

Do USS to investigate these

Causes of secondary hyperoxaluria?

Overall it is due to fat malabs –> short gut, Crohns, CF and pancreatitis

Can lead to oxalate stones

In a patient with a UTI and a large renal stone what is the most likely type of stone?

Struvite (mix of Mg, ammonium, phos and ca due to proteus)

Can cause a large stag horn calculus and renal impairment

Are uric acid stones radio opaque or lucent?

Lucent

Note: radio opaque = ca, struvite and cystine stones

In a patient with grade V VUR when is surgery indicated?

Anyone > 5 yrs old
1-5 years old if bilateral (even if no scarring)
1-5 years old with scarring

Note: if unilateral and no scarring in 1-5 yr old no surgery, only antibiotic prophylaxis

Features of an atypical UTI

Poor urine flow
Abdo and/or bladder mass
Positive culture of non- E coli organism
Raised Cr
Signs of sepsis
Failure to respond to appropriate antibiotic treatment within 48hrs

Note: according to NICE guidelines any children with any feature of atypical UTI need ultrasound

What is the definition of recurrent UTIs

3 or more lower UTIs
OR 2 or more of UTIs of which at least one is upper

Note: prophylactic antibiotics rec for recurrent UTIs

When a patient is having a MCUG for VUR work up what preperation need to be undertaken before hand?

Patient should be started on prophylactic abx orally for 3 days with the MCUG being done on the 2nd day

What is the incidence of hypospadias?

1 in 300 live male births

How does detrusor instability typically present?

Urge incontinence , due to spon contraction of the bladder muscle

Clinical presentation of ureterocele?

1. Recurrent cystitis 2. Renal outflow obstruction which can lead to renal failure Note: can also have no symptoms

Hydrocoele vs varicocoele

Hydrocoele - acute onset, can be post traumatic, transilluminates Varicocoele - chronic onset, "bag of worms" consistency

Relief of pain following elevation of the scrotum is present in what pathology?

Epididymititis. It is known as Prehn sign Note: this is usually absent in torsion

Where does a Gardner duct cyst develop? | Where does a Skene duct cyst develop?

Gardner: Anteriolateral aspect of the superior vagina Skene: Around the urethral opening

Gold standard investigation for Asherman syndrome?

Hysteroscopy or sonohysterography

What is the tx of varicocele?

Observation only Note: surgical correction if persistent severe testicular pain; testicular growth retardation or arrest over a 6-12 month period of observation; volume disparity of over 2mm between testes or if present in a solitary testes

Which side is varicocele more common?

Left

A varicocele in a pre adolescent boy needs a work up. T/F

T - due to association with malignancy (Wilms or neuroblastoma) or obstructive uropathy No work up needed in adolescent

What is paraphimosis?

Inability place the retracted foreskin back to its anatomical position Note: Foreskin retracted past the coronal sulcus may become edematous, making the replacement of the foreskin over the glans more difficult. Reduction is emergent and may require sedation

Balanitis vs balanoposthitis?

Balanitis: inflammation of the glans penis only Balanoposthitis: inflammation of the glans penis and foreskin

In an infant with a weak urine stream what needs to be considered?

If male infant posterior urethral vales

Lifetime risk of testicular cancer is increased in those with an undescended testicle, the risk is present in both testicles T/F

T - the risk of malignancy is increased in both testes even if only one is undescended

Silk glove sign on exam is associated with what pathology?

Inguinal hernia